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GLIFLOZINAS EN EL TRATAMIENTO DE LA DM 2 Y LA INSUFICIENCIA CARDÍACA
Authors: Peláez Herrero, N
Number of views: 37
Type 2 diabetes mellitus (DM2) is a disease that affects the metabolism of carbohydrates, lipids and proteins, is chronic and progressive that is accompanied by a multitude of manifestations that affect the main organs, especially the kidney, heart. Also affecting various tissues and organs other than those already mentioned. These alterations can be serious and even fatal.
We can consider that DM 2 is becoming a public health epidemic worldwide, being related to microvascular and macrovascular complications that are associated with high cardiovascular morbidity and mortality.
Both DM 2 and Heart Failure (HF) have a high prevalence among the population. This prevalence increases as the age of patients increases.
Healthy lifestyle habits and adequate physical exercise can prevent the onset of T2DM. On the contrary, poor eating habits, sedentary lifestyle and obesity can be triggers of it.
Once T2DM is diagnosed, first-line treatment is done with the oral antidiabetic drug, metformin, as long as it is indicated and tolerated by the patient.
The objective is to investigate drugs that are able to adequately regulate blood glucose levels, but at the same time are capable of producing protective effects on organs that can be harmed, above all, that produce beneficial effects on the heart and metabolism in general.
Therefore, in this work of bibliographic review we are going to study the inhibitors of the sodium-glucose cotransporter (iSGLT2), which will act at the level of the renal tubules preventing glucose from being reabsorbed and passing back into the blood, causing, in this way, an increase in urine glucose levels. All this will produce a significant improvement in blood glucose levels and as a consequence there will be weight loss, a reduction in blood pressure, among other benefits.
The fact of these drugs to inhibit the reabsorption of glucose will produce a series of effects such as an increase in the formation of glycogen, an increase in the formation of ketone bodies, a caloric deficit that translates into weight loss and an increase in the sensitivity of cells to insulin.
With respect to the cardioprotective effect, this is due to the fact that they produce hypotension, and a decrease in filling pressures.
The great advantage of these drugs is that their action will not depend on the stage in which the DM2 is, since all these actions do not depend on the levels of insulin secreted by the pancreas. The action of the inhibitors of the sodium-glucose cotransporter SGLT2, at no time, will be related to the levels of the hormone insulin present in the patient, which is a great advantage, because we can use these drugs at any time of the disease.
Likewise, they are able to reduce endothelial dysfunction, inflammation and oxidative stress, which significantly improves their cardiometabolic profile.
We are going to cite the studies and metanalysis that have been carried out until 2022, and we will see how the treatment in DM2 and Heart Failure (HF) is evolving, with these new active ingredients.
Specifically, we will study the 4 active ingredients that are currently being marketed in Europe, namely dapagliflozin, canagliflozin, empagliflozin and ertugliflozin.
However, the efficacy and safety of these active ingredients must be evaluated with daily clinical practice, since they are not exempt from adverse effects, which, in some cases, such as diabetic ketoacidosis (DKA), are more frequent than the studies analyzed say, in addition to being life-threatening. Many of these side effects require hospitalisation and patient monitoring.
Therefore, we ask ourselves, is the use of ISGLT2 justified based on their efficacy/safety?